- Click here for explanation of classification scheme.

The objective of this study was to examine the long-term weight loss maintenance of individuals completing a structured weight loss program.

• Studies were required to:
  • Have been conducted in the United States
  • Have included participants in a structured weight loss program
  • Have provided follow-up data with variance estimates for more than two years
• Primary outcome variables were weight loss maintenance in kilograms, weight loss maintenance as a percent of initial weight loss and weight loss as a percentage of initial body weight (reduced weight).

 

• Two reports were excluded because they did not provide specific weight-loss information at follow-up times
• Another study was excluded because the group included only children of persons with Type 2 diabetes. 

Recruitment

• A MEDLINE literature search for the period of 1970 to 1999 was used to identify candidate studies
• An "ancestry approach" was also used by consulting reference lists from single studies and pertinent literature reviews.

Statistical Analysis

For each study, summary results of all reported values and additional relevant study attributes were recorded, coded and tabulated for analysis.

• The primary effect estimate was calculated as follows: Weight loss maintenance (kg) plus initial body weight minus body weight at follow-up (1)
• Other outcome variables were calculated as follows:
  • Parentage weight loss maintenance (percentage) = (weight loss maintenance / average initial weight loss) x 100 (2)
  • Reduced weight (percentage) = (weight loss maintenance / average initial weight loss) x 100 (3)
• The variance estimates for these two outcome variables, respectively, were calculated as follows:
  • Variance (weight loss maintenance) / (average initial weight loss)²
  • Variance (weight loss maintenance) / (average initial body weight)².

• Timing of measurements: One, two, three, four, five years post-intervention
• Dependent variables:
  • Weight loss maintenance in kilograms
  • Weight loss maintenance as a percent of initial weight loss
  • Weight loss as a percentage of initial body weight (reduced weight)
• Independent variables: Very low energy diets (VLED) and hypoenergetic balanced diets (HBD).

 

 

 Demographic Data for All Studies

Reference	N	Sex	Age (Years)	Diet	Length of Treatment (Weeks)	Initial Weight (Kg)	Weight Loss (Kg)	Follow-up (Years)	Available for Follow-up (Percentage)	Self-Reported Weight (Percentage)
Anderson, et al	71 29	F M	43 43	VLED VLED	17 12	94 116	17.9 18.2	1,2 & 4 1,2 & 4	58 58	100 100
Anderson, et al	72 28	F M	41 41	VLED VLED	22 21	106.8 125.1	31.9 36	1 & 2 1 & 2	73 73	0 0
Anderson, et al	55 25	F M	42 44	VLED VLED	28 23	120.7 148	32.4 41.6	1 & 2 1 & 2	58 58	80 80
Anderson, et al	112 72 40	F&M F M	46 46 43	VLED VLED VLED	22 24 21	108 96.4 128.8	129.1 26.5 35.6	1,2,4, & 5 3 3	100 100 100	30 30 30
Dubbert and Wilson	62	F&M	NA	HBD	19	91.1	7.8	1&2	96	100
Eubank, et al	45	F&M	50	VLED	23	100	28	2	82	4.4
Fitzwater, et al	213	F&M	40	HBD	30	103.4	7.3	2	69	60
Flynn and Walsh	189 66	F M	43	VLED VLED	17 18	102.8 123.9	37.9 39.1	2 2	83 83	100 100
Graham, et al	62	F&M	46	HBD	8	97.7	4.5	5	97	0
Grodstein, et al	325	F&M	NA	VLED	22	105.9	22	3	59	100
Hall	10	F&M	NA	HBD	10	83.3	6.1	2	90	0
Hartman, et al	73 29	F M	42 46	VLED VLED	22 22	99.5 116.5	24.7 33.5	2 2	74 74	43 43
Hensrud, et al	24	F	59	HBD	15	73.5	12.5	1,2,3 & 4	92	12
Holden, et al	80 38	F M	47 46	VLED VLED	23 27	108 140.1	25.2 44.2	3 3	100 100	100 100
Jeffery, et al	89	M	53	HBD	15	100.2	13.5	1 & 2	93	0
Jordon and Canavan	437	F&M	47	HBD	20	97.9	8.5	3 & 5	85	100
Kirschenbaum, et al	65	F&M	38	HBD	12	86.8	6.1	2	90.3	0
Kramer, et al	83 38 114	F&M F M	53 48 51	HBD HBD HBD	15 15 15	100.5 83.1 101.1	13 8.6 13	5 1,2,3,&4 1,2,3,&4	93 76 76	7.2 7.2 7.2
Lavery and Loewry	386 123	F M	45 45	HBD HBD	8 8	78.7 101.3	3.5 6.2	2 2	98 98	100 100
Murphy, et al	34	F&M	NA	HBD	10	87.5	7.4	1,2&4	77	61.8
Nunn, et al	44 16	F M	51 48	VLED VLED	22 22	98.9 119.1	23.2 27.7	1&2 1&2	82 98	18 18
Pavlou, et al	49	F&M	38	HBD	12	100.1	13.3	3	63	4.4
Stunkard and Penick	32	F&M	40	HBD	12	97	8.2	5	84	63
Stalonas, et al	30 6	F M	31 31	HBD HBD	10 10	79.4 101.6	4.9 6.3	5 5	82 82	0 0
Sikand, et al	30	F	39	VLED	17	106.1	19.8	2	50	100
Wadden, et al	50	F&M	44	Mixed	23	108.8	16.1	1&3	90	6.7
Wadden, et al	76	F	42	Mixed	23	106	14.6	1&5	62	47
Wadden and Frey	508 113	F M	44 47	VLED VLED	26 26	104.9 134.1	23.7 34.3	2,3,4&5 2,3,4&5	54 54	100 100
Walsh and Flynn	189 66	F M	45 47	VLED VLED	18 19	100.7 123.3	19.7 27.2	4 4	52.4 66.7	100 100

VLED=Very low calorie diet
HBD=Hyoenergetic balanced diet 

 Weight Maintenance of All Subjects and Selected Subgroups

Group	Years of Follow-up	Number of Studies	Number of Subjects	Initial Weight (Kg)	Weight Loss (Kg)	Weight Loss Maintenance (Kg)	Percentage Weight Loss Maintenance(Kg)	Reduced Weight(Percentage)
All	4.5	13	1081	98	14	3.00 (2.54, 3.45)	23.40 (20.4,26.4)	3.15 (2.69, 3.62)
Men	4.4	5	247	115	18.30	4.70 (2.86, 6.54)	30.50 (21.5,39.4)	4.48 (2.89, 6.06)
Women	4.4	6	534	95	16.60	4.66 (3.52, 5.80)	23.60 (18.4, 28.8)	4.67 (2.55, 5.79)
VLED	4.5	4	578	106	24.10	7.05 (6.04, 8.06)	29.40 (25.2, 33.6)	6.59 (5.65, 7.54)
HBD	4.5	8	448	93	8.80	1.99 (1.47, 5.51)	17.80 (13.4, 22.2)	2.11 (1.56, 2.65)
Lower Exercise	2.7	6	272	110	22.00	7.47 (6.29,8.66)	27.20 (22.8, 34.1)	6.6 (5.61, 7.71)
Higher Exercise	2.7	6	220	110	20.90	14.99 (13.48, 16.49)	53.80 (48.4, 59.2)	12.49 (11.24, 13.74)

 Other Findings

• Exercise appears to be positively related to successful weight loss maintenance
• Use of VLEDs or weight loss of more than 20kg was strongly related to long-term successful weight loss maintenance
• No significant difference was observed in weight loss maintenance or weight reduction between women and men.
• Weight loss maintenance four to five years after a structured weight loss program averaged approximately 3.0kg or approximately 23.4% of initial weight loss, representing a sustained reduction in body weight of 3.2%
• Thirteen very low energy diet  (VLED) studies and 14 hypoenergetic balanced diet studies were evaluated
• Median length of VLED intervention was 22 weeks and median length of HBD intervention was 12 weeks (P<0.001)
• The percentage of individuals at four or five years of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively
• Individuals maintained 67% (95% CI: 65%, 69%) of their initial weight loss at one year, 44% (95% CI: 42%, 46%) at two years, 32% (95% CI: 29%, 32%) at three years, 28% (95% CI: 25%, 30%) at four years and 21% (95% CI: 18%, 25%) at five years.

• This meta-analysis of 29 reports of long-term weight loss maintenance indicated that weight loss maintenance four or five years after a structured weight loss program averages 3.0kg or 23% of initial weight loss, representing a sustained reduction in body weight of 3.2%
• Individuals who participated in a VLED program or lost more than 20kg had a weight loss maintenance at four or five years of 7.0kg or 29% of initial weight loss, representing a sustained reduction in body weight of 6.6%.

Government:	VA-CDEA
Industry:	Health Management Resources Other:
University/Hospital:	VA Medical Center, University of Kentucky
Not-for-profit	0 Foundation associated with industry:

• Meta-analysis of reseach conducted between 1970 to1999
• Most studies made use of VLCD products no longer on the market.